Challenge in South Africa Creating a Speech and Hearing Program at a Historically Black University World Beat
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World Beat  |   May 01, 2003
Challenge in South Africa
Author Notes
  • Gloria Weddington, professor of speech-language pathology at San Jose State University (SJSU), established and managed an SJSU satellite graduate speech-language pathology program in Saudi Arabia and an undergraduate program in partnership with the University of Guam.
    Gloria Weddington, professor of speech-language pathology at San Jose State University (SJSU), established and managed an SJSU satellite graduate speech-language pathology program in Saudi Arabia and an undergraduate program in partnership with the University of Guam.×
  • Sophie Mogotlane, professor of nursing at the University of South Africa and formally dean of applied health sciences at MEDUNSA, spearheaded the establishment of the audiology and speech-language pathology department.
    Sophie Mogotlane, professor of nursing at the University of South Africa and formally dean of applied health sciences at MEDUNSA, spearheaded the establishment of the audiology and speech-language pathology department.×
  • Maggie Tshule, is chair of audiology and speech-language pathology at MEDUNSA and is registered in both speech-language pathology and audiology in South Africa.
    Maggie Tshule, is chair of audiology and speech-language pathology at MEDUNSA and is registered in both speech-language pathology and audiology in South Africa.×
Article Information
Hearing & Speech Perception / Professional Issues & Training / International & Global / World Beat
World Beat   |   May 01, 2003
Challenge in South Africa
The ASHA Leader, May 2003, Vol. 8, 4-18. doi:10.1044/leader.WB.08092003.4
The ASHA Leader, May 2003, Vol. 8, 4-18. doi:10.1044/leader.WB.08092003.4
For most adult Americans, “apartheid,” the most repressive form of racial segregation, is synonymous with South Africa. Apartheid ended in 1994 and was replaced by a democratic government under the leadership of Nelson Mandela, newly released from 27 years of political imprisonment. Although we hoped for the best, we knew that the official end to apartheid would not mean immediate equal access to the riches of the country, but would give black people access to appropriate health care, career options, and a brighter future.
While improvements continue to be made, black South Africans still have a high incidence of health problems, a high infant mortality rate, extreme poverty throughout life, and are unlikely to have access to higher education. In South Africa, most of the universities continue to admit predominantly white students. Without access to a strong secondary school curriculum, black students are afforded little opportunity to meet the criteria for university admission. In addition, there are three public universities that expect students to be fluent in Afrikaans, a language that is spoken only in South Africa and is the official language of the former apartheid government.
Diversity
South Africa is a country of diversity, as indicated by its rainbow people, economy, and until recently, its politics. Seventy-six percent of the total population is black, 12.4% white, 8.4% colored (racially mixed), and 2.5% Asian. Nine of the 11 official languages are black languages that are spoken by 75.5% of the population. Only a quarter (24.5%) of the people speak the two other languages (English and Afrikaans). The typical black resident speaks 3–5 different languages and most reside in rural areas.
During apartheid, black people had separate residences, schools, universities, and hospitals. There was no such thing as equal access. A privileged few black students were admitted to the mainly white colleges and were therefore able to access the speech-language hearing programs. At that time, only one white university admitted black students to its medical school.
The Medical University of Southern Africa
The Medical University of Southern Africa (MEDUNSA) was established at the height of apartheid in 1976, as a facility for black South Africans wishing to become physicians. The institution is attached to an academic provincial hospital in a black township 35 kilometers from the capital city of South Africa, Pretoria.
It was not until 1980 that other allied health and nursing science programs were considered when the first group of medical students was in its fifth year. There was evidence that the institution was attracting a sizable number of interested black students who demanded and received the education required to provide first-rate services to the black populations of South Africa. Indeed, MEDUNSA had become a focal point of interest to a few black health academic professionals, who viewed it as a breakthrough for academic and professional freedom.
When apartheid ended, the institution became categorized as a Historically Disadvantaged Institution or Historically Black University, since admission is open to people of various ethnic backgrounds as well as foreigners. Most of the teaching and administrative staff are black South Africans. The institution educates most of the black physicians and other health care providers in the country, with most choosing to fulfill the numerous health care needs of the black, rural communities.
Speech-Language Pathology and Audiology Program
The establishment of a speech and hearing program was initially approved by the South African Department of Education in 1986. However, the program did not commence at that time for many reasons. First, the black community was unaware of the profession and the need for professional services because the services were not previously available in black institutions.
A second reason was that many black people were struggling with matters of survival and personal safety, and did not perceive the issue of disordered communication as urgent. Black people who had problems such as cleft lip and palate, deafness, and stuttering were generally excluded from the educational system. Similarly, people whose disability in communication was identified after a stroke or head injury were left out of the mainstream of care, at home with their families until they died.
Finally, it was difficult to attract faculty, who would probably be white, to come to MEDUNSA. In 1996, when the offering was revisited, there were only 18 black professionals and only two of them were in the teaching field. These professionals were the privileged few who had gained admission to white universities where they struggled with many inconveniences, including the freedom to use the libraries in the evening when black people had a standing curfew in the city of 11 p.m.
Current Status
In 1996, when the MEDUNSA communication disorders program was finally established, there were similar programs offered in four Historically White Universities (HWU) and one Indian university. There were problems regarding these programs:
  • The number of professionals was not increasing. There were approximately 1,200 speech and hearing professionals, and only about 18 were black.

  • Most of the professionals were not able to provide services to people who speak African languages.

  • Because most of the speech professionals were white, they opted to work in white-only institutions that offered better working conditions, better equipment, and safety, leaving the black institutions without staff to render services.

  • Professionals also could choose to work in private establi shments, leaving the public service with poor resources, or choose to leave the country, depleting the services further.

Alternative Services
In 1984, one of the HWUs introduced a two-year diploma in speech and hearing to mainly black students who, upon completion, would work as community workers under the supervision of professionals.
The health departments in rural provinces had hired these community workers to deliver the full range of speech and hearing services because there was nobody else. However, supervision was not available because there were no qualified professionals working in these areas.
Following their appointment, the community workers, knowing they had limited knowledge and experience, began to submit applications for admission into communication disorders programs at predominantly white universities without success. As all hope of completing a degree program was fading, the Department of Health and Welfare in the Northern Province (now Limpopo Province) requested MEDUNSA to consider the establishment of a speech and hearing program to upgrade the community workers. The program would provide the already practicing workers with an opportunity to qualify as professionals.
To retain these workers, the Northern Province health authorities would keep them in their posts and pay their tuition. The program was planned in blocks wherein the students would alternate theory and practice (i.e., reside at the university for a period of two months and return to their jobs for another two months). It was agreed that, while in the clinical blocks, a mentor would supervise them, and the experience would contribute toward their practicum requirements. At this point, the university consulted their linkage partner, the University of Massachusetts (UMASS), for guidance.
UMASS Partnership
The linkage between MEDUNSA and UMASS allows UMASS to provide technical assistance in medicine and health sciences and exchange activities for faculty and students. USAID provided funds for consultants in speech and hearing to create the curriculum and teach some of the courses. Charlena Seymour and Jane Baran (UMASS), accompanied by Gloria Weddington (San Jose State University in California) and Eugene Wiggins (University of the District of Columbia), traveled to South Africa in February 2000 to develop the curriculum with the help of Maggie Tshule (University of Witwatersrand) and the staff from the speech and hearing clinic at the MEDUNSA University Hospital. The UMASS/MEDUNSA linkage also funded the instructor from the United States for the first classes taught in 2001.
The Program
In South Africa, the typical student enters a four-year bachelor’s program in speech-language pathology and/or audiology after secondary education. Courses are offered in psychology, anatomy, physiology, ethics, normal speech and language development, and linguistics, as well as courses in communication disorders. Clinical practicum in a variety of settings is also required.
At MEDUNSA, the admission criteria also catered to those who had completed a diploma in speech and hearing. Their working experience was also taken into consideration. On assessment, though, it was found that there were major gaps in their knowledge and skills. For example, they had no skill in phonetic transcription, language sampling, or report writing. They reported that their clients’ needs exceeded their clinical knowledge. Based on this, their experience only counted toward their admission into the university program.
Challenges
The MEDUNSA program commenced in February 2001 with the admission of 19 students, 13 of whom had completed the diploma program. A number of challenges continue to impede progress and make it necessary to engage the services of foreign professionals to provide teaching and clinical supervision.
Challenge #1: Faculty Recruitment
Faculty recruitment is the greatest challenge. Advertisements for teaching jobs failed to attract suitable candidates for 2000, 2001, and 2002. This may have been due to various factors: the MEDUNSA students are black; the institution is outside the town of Pretoria, adjacent to a black township; and the university is beset with political strife and, therefore, safety may be an issue.
The implementation of the program became possible through the willingness of the American professionals to assist as instructors and clinical supervisors for little or no salaries. In some cases, they found their own funding. Elise Davis-McFarland (former department chair of the Medical University of South Carolina), for example, obtained a Rotary Club grant to fund travel to teach for three months in 2002; Frances Burns, a doctoral student, was funded by UMASS to teach a module on speech-language pathology for two months; and Jane Baran taught audiology during the summer of 2001 as a volunteer. However, the success of an academic program requires full-time faculty and administrators to make long-term commitments to the program. In addition, local professionals with knowledge of the languages and cultures are preferable to part-time temporary lecturers, regardless of their commitment and willingness to participate.
In May 2001, Maggie Tshule joined the MEDUNSA staff as department chair. Faculty recruitment and retention remains difficult. A full-time instructor was hired in February 2002 but submitted her resignation less than six months later. Subsequent recruitment efforts remain unsuccessful, and the program continues to rely on part-time and foreign lecturers to provide instruction.
Challenge #2: Accreditation
The Speech and Hearing Board in the Health Professions Council of South Africa is the sole accrediting authority for university speech and hearing programs. First, a written document that verifies compliance with requir ements is submitted to the board for approval. Upon approval of the written document, a site visit is scheduled. The MEDUNSA inspection visit occurred in May 2002.
This was too soon, as the program had been in operation for only about a year. The board inspectors were very critical of the American visiting lecturers, even though they were assured that every effort was being taken to ensure that the program remains South African, including the type of student (the previous community workers) and the system used to implement the teaching program.
Challenge 3: Lack of Locally Authored Textbooks, Assessment and Intervention Materials, and Supplies
Research on the prevalence, types, and characteristics of communication disorders in the black populations of South Africa is still needed. With so few researchers in this discipline, especially those who speak the black languages, gaps exist in the information available to students. Textbooks and journals are brought in from Europe and the United States; therefore, students learn about the problems of people in distant lands that may not be relevant to them. Students create their own assessment and intervention materials, as well as supplies for service delivery. They also must develop their own strategies for analyzing language skills of clients, transcribing disordered phonology, and teaching the adult phonological system.
Speech-language pathology is such a new service in the black rural communities that many of the local people are not convinced that treatment could change the way an individual communicates. After assessment, it is rare for clients to return for intervention for more than a few sessions. On the positive side, the students in various classes, under the guidance of their instructors, continue to create crude articulation tests that elicit the speech sounds of the languages represented among the students and language screening tests for children that include familiar pictures to elicit appropriate responses. In addition, fourth-year students are required to conduct a research study that is expected to yield important information for training.
Challenge 4: Limited Library and Instructional Resources
Library books are outdated and no speech and hearing journals are on the shelves, although medical journals in otolaryngology are available. Newer books have been donated by Allyn & Bacon and Singular Press, and speech and hearing professionals continue to donate books and current journals. Duplicate and older books were used to create a library for students in the audiology and speech-language pathology department.
Brighter Future
The new speech and hearing program at MEDUNSA has a bright future, despite the challenges. Diverse clinical opportunities are available to the students throughout South Africa. The MEDUNSA University Hospital Speech and Hearing Clinic is well equipped with up-to-date audiological equipment, and competent clinicians are available for observation and supervision. Teaching positions have been allocated and advertised through the popular media. Two professionals have registered interest and some appointments are expected to be made in 2003. The American lecturers continue to assist with teaching and supervision. The Cultural Attaché of the American Embassy in Pretoria has provided funding for visiting lecturers and maintains active support for the program. Grant proposals have not yet been successful, but the staff and visiting faculty have made a commitment to obtaining funding for additional support for research and equipment.
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May 2003
Volume 8, Issue 9